Postmortem Care

Procedures for death pronouncement vary from state to state
and sometimes within the individual state as well.Your institution will have a set protocol
for you to follow at the time of death that conforms to the regulations in your
area.

No matter your role in death pronouncement, a final nursing
assessment should be performed and documented.Documentation regarding the death of the patient may include:

The patient’s name, time of physician contact, and death
pronunciation

Those present at the time of death- health care personal,
family members, and friends

The time of the assessment

General appearance

Lack of reflex or response to stimulus including pupils that
are fixed and dilated

The absence of breathing and lung sounds

The absence of both apical and carotid pulse

Any other pertinent details from the physical examination

Time the physician assessed the patient or was notified

Identification of all parties notified of the death

Special plans for disposition- organ donation, autopsy, or
cultural/religious needs

After death, the body should be prepared in order to give a
clean, peaceful impression for those family members who desire an opportunity
to say good-bye before funeral home removal.Kindly caring for the body shows the family empathy and concern, the
continued value of the deceased, as well as modeling grief facilitating
behaviors for others present.Religious
or cultural practices the family may find comforting should be encouraged.It is also appropriate to invite them to
participate in the preparation of the body.

There are three categories of change that will occur in the
body after death.These are algor
mortis, postmortem decomposition, and rigor mortis.

Algor mortis occurs from a lack circulation.The hypothalamus stops functioning and the
body’s core temperature begins to drop by about 1.8 degrees every hour until it
reaches a stasis at room temperature.The skin begins to lose its natural elasticity as the body cools.If a high fever was present at the time of
death, the person may lose excess fluid through the skin causing the skin to
feel moist, or giving the appearance of sweating even after death.This loss of moisture and elasticity causes
the skin to become more fragile and easily damaged.The body should be handled gently, avoiding
excess pressure or traction on the skin.

Unless otherwise indicated by protocol or the need for
autopsy, any tubes, drains, and other medical devices should be removed.Bandages should be applied as fluids may
still be expressed as the body loses elasticity.Because the skin can be so easily damaged,
these dressings should be applied with a wrap or paper tape.

Postmortem decomposition refers to bruising and softening of
the body that is largely related to the breakdown of red blood cells.As these cells breakdown, hemoglobin is
released resulting in a staining effect on the vessel walls and surrounding
tissues.This mottling or bruising most
frequently appears on dependent parts of the body as well as any areas of the
body having experience recent trauma such as puncture wounds from invasive
procedures.The face most often appears
purple in color when death is the result of cardiac complications.The remainder of the body takes on a gray
hue.This discoloration can spread very
rapidly.The nurse should assure family
members that this bruising process is a normal.

Rigor mortis begins within four hours of death, as adenosine
triphosphate (ATP) is no longer synthesized due to the depletion of glycogen stores.ATP effects muscle fiber relaxation. Its
absence causes an exaggerated contraction of the muscle fibers and immobilizes
the joints.Rigor begins in the
involuntary muscles of the heart, gastrointestinal tract, bladder, and
arteries.It then progresses through the
muscles of the head, neck, trunk and lower limbs.However, after approximately 96 hours the muscle
activity totally ceases and the rigor passes.Those with large muscle mass may experience more pronounced rigor
mortis.On the other hand, frail
individuals are less prone toward to rigor mortis.

Post-death positioning to minimize the effects of rigor
mortis should include placing the limbs and hands are in proper body
alignment.The eyelids and jaw should be
closed and dentures should be in place in the mouth. A waterproof pad or
incontinence brief underneath the body is also helpful for containing body fluids
that may be expressed during this process.However, the practice of packing the vagina or rectum is
unnecessary.

Other common courtesies include washing the body and combing
the hair.The nurse or family may also consider
dressing the body in something normalizing rather than hospital attire.It should also be noted that the body may
“sigh” as it is rolled. The movement causes the lungs to compressed and expel
air.When family members are involved in
the care, they should also be notified of this possibility.

Family and friends should not be rushed during the initial
grieving process.If the area is kept
cool, the decomposition process will be slowed allowing the family time to
grieve.

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